Spinal stenosis

• Spinal stenosis refers to the narrowing of the part of the spinal canal - resulting in compression of the spinal cord or nerve roots

  Usually affects the cervical or lumbar spine - most common type is lumbar spinal stenosis
• Spinal stenosis is more likely to occur in patients older than 60 years, relating to degenerative changes in the spine. 
• There are three types:

  • Central stenosis – narrowing of the central spinal canal
  • Lateral stenosis – narrowing of the nerve root canals
  • Foramina stenosis – narrowing of the intervertebral foramina
• Causes:

  • Congenital
  • Degenerative changes - facet joint changes, disc disease and bone spurs
  • Herniated discs
  • Thickening of posterior ligament
  • Spinal fractures
  • Spondylolisthesis - anterior displacement of vertebra
  • Spinal tumours
• Presentation:

  • Gradual onset
  • Can vary from mild compression to severe with features of cauda equina syndrome
  • Intermittent neurogenic claudication - key presenting feature of central stenosis
  • Symptoms absent at rest but occur with standing and walking
  • Flexing the spine expands the spinal canal and improves symptoms
  • Extending the spine (standing straight) narrows the canal and worsens symptoms
  • Lateral and foramina stenosis tend to cause sciatica
• Intermittent neurogenic claudication:

  • Lower back pain
  • Buttock and leg pain
  • Leg weakness
• Imaging:

  • MRI spine
  • Investigations to exclude PAD (e.g. ABPI and CT angiogram) may be needed when symptoms of intermittent claudication are present
• Management:

  • Exercise and weight loss
  • Analgesia - NSAIDs, gabapentin
  • Physiotherapy
  • Decompression surgery - laminectomy
• Laminectomy refers to the removal of part or all of the lamina from the affected vertebra. The laminae are the bony parts that form the posterior part of the vertebral foramen (forming the spinal canal) and attaches to the spinous process.